Letter to the Editor
Serratia marcescens septic sternoclavicular joint arthritis: A case report
Artritis séptica esternoclavicular por Serratia marcescens: a propósito de un caso
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It is frequently associated with predisposing conditions, such as intravenous drug abuse or diabetes. Given the infrequency of the disease, the diagnosis is often delayed.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleItalic">Serratia marcescens</span> is a Gram-negative enterobacterium associated with a wide range of nosocomial infections.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report a case of sternoclavicular joint septic arthritis caused by this enterobacterium. The patient was a 70-year-old man diagnosed with hypertension, type 2 diabetes, dyslipidemia and chronic ischemic heart disease in the form of unstable angina, with percutaneous revascularization of anterior descending and circumflex arteries. On admission to the hospital for unstable angina, catheterization revealed no evidence of new coronary lesions. On the third day of his hospital stay, he experienced chills, pain in his left shoulder and dysphagia. On clinical examination, the only notable findings were an arterial blood pressure of 150/76<span class="elsevierStyleHsp" style=""></span>mmHg, body temperature of 38<span class="elsevierStyleHsp" style=""></span>°C, edema and erythema in left sternoclavicular joint, and pain on moving his left arm. The analytical findings included a hemoglobin level of 11.2<span class="elsevierStyleHsp" style=""></span>g/dL and leukocyte count at 3600/mm<span class="elsevierStyleSup">3</span>, with 7.5% lymphocytes and 85.8% neutrophils, platelet count of 84,000/mm<span class="elsevierStyleSup">3</span> and C-reactive protein at 325<span class="elsevierStyleHsp" style=""></span>mg/L. Blood cultures revealed the presence of <span class="elsevierStyleItalic">Serratia marcescens</span> sensitive to quinolones, carbapenems, aminoglycosides and third-generation cephalosporins. Computed tomography of his neck and chest (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) confirmed the presence of an infectious process in the sternoclavicular joint, with no signs of local complications. The results of an otorhinolaryngological examination were normal. It was not possible to obtain a sample of joint fluid. There was no evidence of endocarditis on transthoracic echocardiography. He was treated with 1<span class="elsevierStyleHsp" style=""></span>g/day of intravenous ertapenem for 4 weeks, followed by a 2-week regimen of oral ciprofloxacin (500<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h). In view of the favorable clinical response and analytical findings, surgical treatment was ruled out.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Septic arthritis of the sternoclavicular joint is an uncommon disease<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> in both immunocompetent and immunocompromised individuals.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> The risk factors are diabetes mellitus, rheumatoid arthritis, intravenous drug abuse, neoplastic diseases, chronic kidney disease, human immunodeficiency virus infection, cirrhosis, local trauma and central line infections.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> The fact that our patient was a diabetic and, moreover, had undergone cardiac catheterization is important. <span class="elsevierStyleItalic">Staphylococcus aureus</span> is the most common causative agent.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> Until now, there has been only one case attributed to infection by <span class="elsevierStyleItalic">Serratia marcescens</span> in the medical literature.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> The most common mechanism of infection is bacteremia.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> Patients may complain for days or even months of pain in shoulders, neck or chest, with limited arm mobility, associated with fever. The clinical picture in our patient was similar to those reported by other authors. However, we consider that the dysphagia was related to extrinsic compression of the esophagus.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Joint inflammation and erythema can also be present. Sternoclavicular arthritis is generally unilateral, and is right-sided in 60% of the cases. Bacteremia is found in 62% of the patients. Computed tomography is the initial imaging technique that can identify bone involvement and detect retrosternal dissemination. The most serious complication is mediastinitis, which occurs in 15% of the cases.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> The initial therapeutic approach includes prolonged antibiotic therapy when there are no complications. However, in the presence of extensive osteomyelitis, abscesses or mediastinitis, surgical treatment is recommended.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> Debridement is the surgical technique associated with the lowest incidence of complications.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> In conclusion, septic arthritis of the sternoclavicular joint is uncommon, especially that caused by enterobacteria. However, it is potentially disabling and fatal, and should be suspected in any condition that affects the sternoclavicular region.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Amao-Ruiz E, Correa-Fernandez AM, de la Fuente Galán L. Artritis séptica esternoclavicular por <span class="elsevierStyleItalic">Serratia marcescens</span>: a propósito de un caso. Reumatol Clin. 2016;12:238–239.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 802 "Ancho" => 950 "Tamanyo" => 91426 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Augmentation of soft tissue and obliteration of fat planes associated with the inflammatory-infectious process in left sternoclavicular joint (arrows).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Septic arthritis of the sterno-clavicular joint as a cause of dysphagia: a report of two cases and review of literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.K. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 53 | 27 | 80 |
| 2024 September | 67 | 51 | 118 |
| 2024 August | 82 | 63 | 145 |
| 2024 July | 58 | 32 | 90 |
| 2024 June | 73 | 34 | 107 |
| 2024 May | 58 | 34 | 92 |
| 2024 April | 57 | 16 | 73 |
| 2024 March | 67 | 36 | 103 |
| 2024 February | 51 | 26 | 77 |
| 2024 January | 56 | 23 | 79 |
| 2023 December | 44 | 26 | 70 |
| 2023 November | 39 | 19 | 58 |
| 2023 October | 38 | 27 | 65 |
| 2023 September | 67 | 39 | 106 |
| 2023 August | 42 | 13 | 55 |
| 2023 July | 40 | 23 | 63 |
| 2023 June | 40 | 24 | 64 |
| 2023 May | 42 | 20 | 62 |
| 2023 April | 44 | 14 | 58 |
| 2023 March | 65 | 29 | 94 |
| 2023 February | 57 | 29 | 86 |
| 2023 January | 42 | 24 | 66 |
| 2022 December | 53 | 42 | 95 |
| 2022 November | 58 | 33 | 91 |
| 2022 October | 66 | 29 | 95 |
| 2022 September | 73 | 32 | 105 |
| 2022 August | 36 | 45 | 81 |
| 2022 July | 44 | 63 | 107 |
| 2022 June | 61 | 28 | 89 |
| 2022 May | 35 | 37 | 72 |
| 2022 April | 33 | 46 | 79 |
| 2022 March | 33 | 27 | 60 |
| 2022 February | 25 | 22 | 47 |
| 2022 January | 24 | 46 | 70 |
| 2021 December | 41 | 37 | 78 |
| 2021 November | 27 | 41 | 68 |
| 2021 October | 48 | 54 | 102 |
| 2021 September | 36 | 36 | 72 |
| 2021 August | 27 | 34 | 61 |
| 2021 July | 28 | 27 | 55 |
| 2021 June | 25 | 23 | 48 |
| 2021 May | 48 | 51 | 99 |
| 2021 April | 71 | 74 | 145 |
| 2021 March | 49 | 27 | 76 |
| 2021 February | 46 | 16 | 62 |
| 2021 January | 39 | 18 | 57 |
| 2020 December | 32 | 19 | 51 |
| 2020 November | 63 | 23 | 86 |
| 2020 October | 30 | 24 | 54 |
| 2020 September | 44 | 24 | 68 |
| 2020 August | 40 | 22 | 62 |
| 2020 July | 45 | 25 | 70 |
| 2020 June | 47 | 26 | 73 |
| 2020 May | 38 | 19 | 57 |
| 2020 April | 30 | 19 | 49 |
| 2020 March | 23 | 5 | 28 |
| 2020 February | 1 | 0 | 1 |
| 2018 May | 4 | 0 | 4 |
| 2018 April | 128 | 6 | 134 |
| 2018 March | 40 | 4 | 44 |
| 2018 February | 18 | 6 | 24 |
| 2018 January | 18 | 3 | 21 |
| 2017 December | 27 | 2 | 29 |
| 2017 November | 28 | 5 | 33 |
| 2017 October | 22 | 5 | 27 |
| 2017 September | 15 | 3 | 18 |
| 2017 August | 22 | 6 | 28 |
| 2017 July | 30 | 10 | 40 |
| 2017 June | 36 | 10 | 46 |
| 2017 May | 54 | 8 | 62 |
| 2017 April | 43 | 8 | 51 |
| 2017 March | 37 | 9 | 46 |
| 2017 February | 13 | 6 | 19 |
| 2017 January | 26 | 4 | 30 |
| 2016 December | 58 | 19 | 77 |
| 2016 November | 40 | 33 | 73 |
| 2016 October | 71 | 36 | 107 |
| 2016 September | 80 | 43 | 123 |
| 2016 August | 115 | 34 | 149 |
| 2016 July | 64 | 39 | 103 |
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